R33TW011665

Development and Testing of a Mobile Application to Enhance HIV Prevention Cascade in Malaysian MSM - Abstract

Malaysia's HIV epidemic is rapidly expanding, with recent evidence suggesting accelerated sexual transmission, especially in men who have sex with men (MSM). The prevalence of HIV in MSM is high, both nationally (21.6%) and in Kuala Lumpur (43%). Condomless sex, sexually transmitted infections (STIs), and co-occurring psychiatric and substance use disorders (P/SUD), particularly depression and amphetamine-type stimulant (ATS) use, are central to this expanding HIV epidemic in MSM.

Insights into Malaysia's HIV prevention gap are multi-factorial. Homosexuality and substance use are criminalized in Malaysia, which places MSM at the dual burden of stigma and discrimination, including in healthcare. This promotes disparities in P/SUD among MSM. MSM often hesitate to disclose their sexuality, risk behaviors, or depressive symptoms due to fear of stigma, discrimination, or criminalization. Stigma and discrimination are also enacted on MSM by healthcare providers, resulting in extraordinary health disparities and low prevention uptake.

Strategies that facilitate screening and prevention practices in a non-judgmental fashion are likely to increase access to evidence-based prevention, such as HIV testing and pre-exposure prophylaxis (PrEP), especially if screening and counseling address P/SUD. Introducing an innovative app-based platform to deliver holistic HIV prevention services represents a paradigm shift in HIV prevention, as it can deliver effective prevention in a confidential, less stigmatizing, and convenient manner.

Building on the advantages for scalability and dissemination afforded by using an app platform, we propose to develop and test the efficacy of a clinic-affiliated app (MyCareLink) to deliver an integrated HIV prevention intervention. This intervention will promote HIV testing and linkage to PrEP and incorporate screening and support for underlying P/SUD in Malaysian MSM.

The design of this study will take place in two phases. The R21 phase will consist of two stages: 1) adapting, expanding, and refining an existing app, which will be integrated within the existing clinical care system. First, we will conduct focus groups with MSM (N=25) and stakeholders (N=10) to theater test the existing app and develop an interactive prototype of the MyCareLink app (alpha version). Then, the prototype will undergo usability testing (N=20), followed by the full development of the app (beta version); 2) expanded beta testing (N=50) of the MyCareLink app to assess its usability and acceptability.

The R33 phase will involve conducting a type 1 hybrid implementation science trial to evaluate the efficacy of the MyCareLink app versus treatment as usual (TAU) in 268 Malaysian MSM for primary (HIV testing and PrEP uptake) and secondary (PrEP adherence and persistence) efficacy outcomes. Multi-level implementation outcomes will involve stakeholders' perspective on the relative advantage of the MyCareLink app over TAU, adaptability, perceived design quality and packaging, compatibility in the Malaysian context, interest in sharing the app with others, and readiness for implementation.

Research capacity strengthening between Yale and the University of Malaya will occur through collaborative learning between researchers at both institutions to promote the expansion of mHealth research.

University Of Connecticut

THE JOHN E. FOGARTY INTERNATIONAL CENTER (FIC) SUPPORTS RESEARCH AND RESEARCH TRAINING TO REDUCE DISPARITIES IN GLOBAL HEALTH AND TO FOSTER PARTNERSHIPS BETWEEN U.S. SCIENTISTS AND THEIR COUNTERPARTS ABROAD. FIC SUPPORTS BASIC BIOLOGICAL, BEHAVIORAL, AND SOCIAL SCIENCE RESEARCH, AS WELL AS RELATED RESEARCH TRAINING AND CAREER DEVELOPMENT. THE RESEARCH PORTFOLIO IS DIVIDED INTO SEVERAL PROGRAMS THAT SUPPORT A WIDE VARIETY OF FUNDING MECHANISMS TO MEET PROGRAMMATIC OBJECTIVES.

93.989 - International Research and Research Training

Fogarty International Center (FIC) [HHS - NIH]

Connecticut United States

State-Wide

Mobile Health: Technology and Outcomes in Low and Middle Income Countries (R21/R33 - Clinical Trial Optional) (PAR-19-376)

Termination This project grant was reported as terminated by the Department of Government Efficiency (DOGE) in July 2025. See All
Amendment Since initial award the End Date has been extended from 06/30/25 to 06/30/26 and the total obligations have increased 223% from $296,097 to $955,740.